Background
There is paucity of data regarding clinical characteristics, laboratory parameters and outcomes of coronavirus disease (COVID‐19) in cancer versus non‐cancer patients, particularly from India.
Materials and Methods
This was an observational, single‐centre, retrospective analysis of patients with laboratory‐confirmed COVID‐19 hospitalised in our institution between 22 May 2020 and 1 December 2020. We compared baseline clinical characteristics, laboratory parameters and outcomes of COVID‐19 (overall mortality, time to discharge) between cancer and non‐cancer patients.
Results
A total of 200 COVID‐19 infection episodes were analysed of which 109 (54.5%) were patients with cancer and 91 (45.5%) were patients without cancer. The median age was 43 (interquartile range [IQR]:32–57), 51 (IQR: 33–62) and 38 (IQR: 31.5–49.3) years; of whole cohort, cancer and non‐cancer patients, respectively. Comparison of outcomes showed that oxygen requirement (31.2% [95% CI: 22.6–40.7] vs. 17.6% [95% CI: 10.4–26.9];
p
= 0.03), median time to discharge (11 days [IQR: 6.75–16] vs. 6 days [IQR: 3–9.75];
p
< 0.001) and mortality (10.0% [95% CI: 5.2–17.3] vs. 1.1% [95% CI: 0.03–5.9];
p
= 0.017) were significantly higher in patients with cancer. In univariable analysis, factors associated with higher mortality in the whole cohort included diagnosis of cancer (10.1% vs. 1.1%;
p
= 0.027; odds ratio [OR]: 7.04), age ≥60 (17.4% vs. 2.6%;
p
= 0.001; OR: 7.38), oxygen requirement (22% vs. 0.6%;
p
< 0.001; OR: 29.01), chest infiltrates (19.2% vs. 1.4%;
p
< 0.001; OR: 22.65), baseline absolute lymphocyte count <1 × 10
9
/L (10.8% vs. 1.9%;
p
= 0.023; OR:5.1), C‐reactive protein >1 mg% (12.8% vs. 0%;
p
= 0.027; OR: 24.69), serum procalcitonin >0.05 ng/ml (22.65% vs. 0%;
p
= 0.004; OR: 4.49) and interleukin‐6 >6 pg/ml (10.8% vs. 1.3%;
p
= 0.036; OR: 3.08). In multivariable logistic regression, factors significantly associated with mortality were oxygen requirement (
p
= 0.005; OR: 13.11) and high baseline procalcitonin level (
p
= 0.014; OR: 37.6).
Conclusion
Cancer patients with COVID‐19 have higher mortality and require longer hospital stay. High procalcitonin levels and oxygen requirement during admission are other factors that affect outcomes adversely.
Although majority of cases with SARS COV-2 infection have mild symptoms or are asymptomatic, 10% patients have a severe disease. 1 As of 10th January 2021, according to current WHO data, there are 88 million cases worldwide, with 2.1% mortality rate. 2 A study from China which analysed 1590 COVID patients across 575 hospitals, showed that cancer patients are at higher risk of developing SARS-CoV-2 infection, and five times more likely to develop severe events such as use of mechanical ventilator, and death, compared to non-cancer patients. 3 Amongst cancer patients, those with hematological malignancies, who undergo HSCT and develop complications like GVHD, are even more susceptible to death from COVID-19 because of profound immunosuppression. 4 There is paucity of literature on COVID-19 in HSCT. We describe here the course and outcome of a patient who, after HSCT (complicated with extensive chronic GVHD including lung), developed severe COVID-19 and recovered completely.
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